[Question #13102] Questions about risk
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2 months ago
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I had an incident a while back, but now I have doubts about
the possible risks.
I was in a 9 month relationship with a woman, and all of our
relationships we used condoms. In our conversations, she said that she always
used condoms in other relationships.
One time, after vaginal intercourse, I removed the condom
and it seemed intact, there was no visible breakage and I even stretched it a
few times. I went to the bathroom, filled the condom with water and there was a
small leak, as it was a long time ago, I don't remember very well, but the leak
seemed to be about 5 cm from the tip of the condom, where the reservoir is. The
urethra was completely protected.
My question is: is there any real risk of HIV in this
situation? Most of the time I checked the condom with water, but sometimes I
didn't, so I wonder if a small leak could have occurred and I didn't see it.
There was never a complete breakage of the condom.
This event occurred almost 4 years ago and I have never had
any serious health problems during that time.
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H. Hunter Handsfield, MD
2 months ago
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Welcome to the forum. I'm happy to help. The quick answer is that there definitely was not "any real risk of HIV in this situation".
You describe a partner exceedingly unlikely to have HIV. Even with entirely unprotected sex, the average HIV transmission risk -- if the female partner has HIV -- is around once for every 2,000 vaginal sex exposures. That there was "no visible breakage" was evidence the condom worked; the small water leak afterward did not materially raise the risk. (We recommend against looking for small holes or doing a "water test". The results never make a difference in risk. I suggest you stop doing this.) You're also correct that if the head of the penis and urethra are covered, condom protection is complete. Considering all these factors, the chance you were infected with HIV is under one chance in millions. That you have been outwardly healthy in the last four years makes HIV even more unlikely.
You might consider HIV testing anyway. Every person who is or has been sexually active outside a mutually monogamous relationship should be tested for HIV from time to time. And even with virtually zero risk, reassurance alone is a valid reason for testing. This doesn't imply I believe you were at risk from the relationship described; I do not. But some people are more reassured by negative test results than by professional opinion, no matter how expert. (We don't take it personally!) It's up to you of course.
I hope this reply is helpful. Let me know if anything isn't clear.
HHH, MD
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2 months ago
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Thank you for your response.
When you say there are no real risks, is that because it is just a small leak in the condom? Even with small flaws that can occur in the condom, isn't that the same as having completely unprotected sex or a complete rupture that exposes the entire penis?
And after all this time without health problems, is that also a good indicator?
Thank you.
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H. Hunter Handsfield, MD
2 months ago
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Sorry for the unusual delay in this reply.
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"There are no real risks" means the overall situation was extremely low risk for HIV and all STIs. It doesn't imply anything at all about the condoms. There is no such thing as "small flaws" in condoms that permit HIV/STI transmission; that's an urban myth, nothing more. A theoretical condom with such a defect definitely is NOT " the same as having completely unprotected sex or a complete rupture".
And yes, absence of symptoms after 9 months is pretty good evidence against HIV or other STIs. However, see my statement above "You might consider...." That you continue to ask these somewhat irrational questions implies you have uresolved anxieties about your partner and your sexual relationship with her. Probably you're going to continue to worry about it no matter what I might say. So my advice remains that you be tested for reassurance: HIV and syphilis blood tests and a urine test for gonorrhea/chlamydia.
I'll be happy to comment one last time if you decide to test and would like to tell me about the results.
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1 months ago
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Thank you, Dr. Handsfield.
But the incident was not 9 months ago. The incident was 4 years ago.
1 - So, small leaks found in condoms do not pose a risk for HIV, as long as there is no complete rupture? Is this correct?
2 - And after 4 years of exposure, would I already know or would there be strong evidence that I was infected?
Another question, a little off topic.
I have seen in several posts by you and Dr. Hook that small amounts of blood outside the body and exposed to the environment would immediately render the virus non-infectious.
3 - A very small amount of blood, barely noticeable, would the virus die or become non-infectious when exposed to an object almost immediately?
Thank you for answering my questions and I apologize if I was repetitive. I am planning to get tested.
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H. Hunter Handsfield, MD
1 months ago
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Sorry I misread the time of the exposure on your mind; your opening question referred to a relationship of 9 months duration which explains my misunderstanding. Anyway, no symptoms after 4 years is a bit (but only a bit) more reassuring that don't have HIV. Anyway, you already have the important part of my advice and plan to follow through with testing.
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1. Reread the opening comments in my initial reply above. This statement shows you correctly understood it -- and I haven't changed my mind in the last two weeks!
2. See just above. Absence of symptoms at 4 years is slightly reassuring, but not necessarily; many HIV infected people have no symptoms after 4 years.
3. No. The virus does not die or become non-infectious that quickly. The time for virus inactivation depends on temperature, whether or not the blood has had time to dry, and other factors. It could survive for several hours in some circumstances. But this isn't important at all: nobody in the world has ever been known to catch HIV from contact with blood in the environment.
As in my opening comments two weeks ago, you were at little or no risk of HIV. Your test result will be negative. Don't follow up with more questions before then; there is nothing more we can say. It's pointless to keep asking when the answer will be at hand. In the 21 years of this and our preceding forum, with thousands of questions from persons worried about HIV after a possible exposure, nobody has yet tested positive. You won't be the first. If and when it finally happens, it will not be from a near zero risk exposure like yours, but from a genuine high risk event; think unprotected anal between two men, for example.
That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.